PRE 2010 DOCSCITY OF FRIDLEY INSPECTION DIV,
6431 University Ave NE
Fridley, MN 55432
572-3604
Residential .
Furnace Shell and Duct Work, Burner Y -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Ranga
Gas Dryer
y
*Air Conditioring — All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
I% of Value of Appliance or Work
Commercial/industrial
1.25% of Value of Appliance or Work
r '
Rate TOTAL
$ 30.00 $
$10.00 $
$10.00
$10.00 $
$ 25.00 $
State Surcharge
TOTAL FEE
MINIMUM FEE FOR' ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
'50
Effective On August 1, 1995
JOBADDRESS
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and hereby'declares that all the facts and
representations stated in this application are true and correct.
AO 7 ,1.995x°
OWNER s o -o Id . e' r r
BUILDING USED AS�;aa�a
ESTIMATED COST PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One *(Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU:' • _HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HPI EDR
MINNEGASCO
ATFN: JUDI - 321-5282
HEATING COMPANY P®. 9®x 1165
Signed
Approved
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE
written permission from adjoining property owner. REPLACEMENT FURI
Tel No.
_ Rough—In Date Final Date
STACK VERIFICATION ON
CHIMNEY AND STACK VERIFICATIO
The undersigned hereby verifies that the existing chimney or stack:
1.
Has beep- carefully examined
Yes ()
No
(
)
.2.
Is free from rust or deterioration
Yes
O
No
(
)
3.
Ha aD foreign, objects lodged within
Yes ()
No
:.... _
4
Is surely supported
Yes.:..
()
No
{)
5.
Meed all current Code requirements for size
and - BTU'.s connected .. , . .. m .K
.-Yes (}
No
6
Has,, total heating BTU's of
Alla,qW, ' BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
hUNNECASCO
ATTN: JUDI - 321.5282
P.O. BOX 1165
MPLS., MN 55440.1165
-c rk;
01
SUBJEa:T -
.
City of Fridley
30281
AT THE TOP OF THE TWINS
BUILDING
PERMIT
�
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
PROTECTIVE
\�d1
1 �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
� CITY HALL FRIDLEV 55432
612-571-3450
910-F15
9/23/99
108 ADDRESS
5920 Stinson Blvd.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2C,
Aud. Sub.
SHEET
2 RROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Michael H. Spencer
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and earage (28 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with theState Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
JSTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2447
$1.22
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$83.25
Fim SC $2.455
PLAN CHECK FEE7Z.
FEE
92
SIGN UR F ONTR CTORORAUTHORIZEDAGENT,_ iDATEi
EN PRO
VALI T THIS IS PERM[
/����
s
S NATURE OF OW iDATEj
Ell NSP
r TE
01
VW
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 1 I�
BUILDING PERMIT APPLICATION
Construction Address: 5',)z6 57 , v�j s(9 )-' B L y n
Legal Description:
Owner Name &Address: Tel. #
Contractor: Ou.) Q ,�A MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF BIPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER: R '� RW -P N W S:Z �f 4, iA R P\G ::�
Construction Type:
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
T5A R 6PF
Estimated Cost: $�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: 3:W APPLICANT: Tel. # I (� 36 -3431
CITY USE ONLY
Permit Fee $ (S
Fire Surcharge $ o� S
State Surcharge $
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ - o�
STIPULATIONS:
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]